FNP Certification Review 3rd ed (Leik) - Study Questions and answers

Which medications are associated with the highest incidence of erectile dysfunction? SSRI -- Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) that causes sexual adverse effects (impotence, inability to reach orgasm) in up to 50% of men who take it. Of all the SSRIs, it seems to be the one with the highest risk of erectile dysfunction. tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia hemoglobin electrophoresis Stepwise approach to treating acne vulgaris 1. Topical agents are the first-line treatment for acne vulgaris 2. Retin-A 0.25% gel 3. Oral preparations (tetracycline) 4. Accutane 1. What is the least common pathogen found in community-acquired pneumonia? 2. Common in 3. Treatment 1. P. aeruginosa is an uncommon cause of community-acquired pneumonia. 2. It is more common in patients with cystic fibrosis and hospitalized patients. 3. In mild cases, it can be treated with ciprofloxacin (Cipro) or levofloxacin (Levaquin), which are fluoroquinolones. P. aeruginosa is resistant to several antibiotics and it can be tricky to treat. Many patients need hospitalization. maculopapular rash is noted to have areas of central clearing making it resemble a round target. (Disease/Host/Organism) Erythema migrans is a symptom of early Lyme disease. It is an annular lesion that slowly enlarges with time (days to weeks) and has central clearing. It is caused by a bite from an infected (Borrelia burgdorferi) blacklegged tick. If untreated, infection will spread to joints, nervous system, and heart. Most cases of Lyme disease occur in the Northeast, mid-Atlantic states, Wisconsin, Minnesota, and northern California. A chest radiograph shows an area of consolidation on the lower lobe. What conditions is most likely Bacterial pneumonia Pneumonia is an inflammatory condition of the lung especially affecting the alveoli. It is associated with fever, chest symptoms, and consolidation on a chest x-ray. Infectious agents include bacteria, viruses, fungi, and parasites. Consolidation is not present in the lungs with bronchitis, chronic obstructive pulmonary disease (COPD), or atypical pneumonia. Which drug class is preferred initially to treat symptoms of GERD? A proton pump inhibitor (PPI) trial for 8 weeks is preferred for the treatment of moderate/severe GERD whose symptoms are not responding to lifestyle changes. Given the frequency of symptoms, a step-down approach should be considered in this patient. 1. side effect from the use of nifedipine (Procardia XL) 2. Classification? 1. edema of the ankles, dizziness, headaches, flushing, and weakness. 2. calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors tend to have the side effects of angioedema and a dry hacking cough Diuretics can cause side effects of hyperkalemia and hyperuricemia Downs syndrome can play contact sports if check for cervical instability Atlantoaxial instability (AAI) denotes increased mobility at the articulation of the first and second cervical vertebrae (atlantoaxial joint). The American Academy of Pediatrics issued a position statement in 1984 on AAI and Down syndrome (DS): All children with DS who wish to participate in sports should have cervical spine x-rays. Repeated x-rays are not indicated for children with DS who have had a previously normal neck x-ray. Persons with DS who have no evidence of AAI may participate in all sports. Nonhealing ulcers of the skin are a risk for skin cancer and patients should be treated how? referral -- evaluated by a dermatologist for treatment Acute alcohol withdrawal delirium is managed with benzodiazepines Rhabdomyolysis rapid breakdown of skeletal muscle; muscle pain/weakness, dark urine... it releases large amounts of myoglobin, which is toxic to the kidneys. It can result in acute kidney injury or acute renal failure. There are many causes such as severe exercise, traumatic crush injuries, medicines (statins, fibrates especially if combined), illicit drugs, and others. The signs and symptoms of rhabdomyolysis are muscle pain (shoulders, thighs, calves, lower back), muscle weakness, dark-red or brown urine, fever, tachycardia, and/or decreased urination. Almost half of patients report no muscular symptoms. Sensorineural hearing loss (i.e., presbycusis) involves damage to the hair cells in the cochlea (sensory portion) and may involve cranial nerve VIII (neural). Describe Osgood-Schlatter disease characterized by pain over the tibial tuberosity with palpation of a bony mass over the anterior tubercle of one or both knees. Exercise worsens the pain. painful lumps on knees. bonelike growth on the upper tibia midline below the kneecap on both knees. full range of motion with no joint tenderness, redness, or swelling Describe Transient ischemic attack (TIA) 1. Causes 2. Secondary prevention 3. sx 4. DDx stroke A TIA is a transient episode of neurologic dysfunction due to focal brain, spinal cord, or retinal ischemia, without acute infarction. Originally, TIA was defined as sudden onset of focal neurologic signs and/or symptoms lasting fewer than 24 hours. Patients with suspected TIA require urgent evaluation due to the high risk of stroke. An MRI of the brain is preferred to a CT of the brain. 1. A search for the cause of the TIA includes conditions such as hypertension, blood clot from the heart, carotid blockage, and so forth. 2. For secondary prevention, aspirin therapy and statin therapy are recommended. Some patients may need antithrombotics. 3. Symptoms of a TIA are the same as a stroke but last only a short time. 4. The mnemonic is "FAST" with F (one side of face is drooping), A (ask patient to raise both arms, does one arm drift downward?), S (slurred speech), and T (time; if present, call 911). These signs are seen in stroke along with change in level of consciousness, confusion or memory loss, difficulty swallowing, difficulty writing, inability to recognize objects/people, incontinence, and trouble speaking or understanding others. What substance is responsible for the symptoms of dysmenorrhea? Prostaglandins hormones the body produces prior to menses they eventually cause the uterus to contract to shed the endometrial lining. Contractions cause pain. The greater the amount of prostaglandins that are released, the more pain one will experience. Contractions of the uterus cause vasoconstriction of blood supply to the uterus, which, in turn, will cause pain. Actinic keratoses 1. Description / cause small, raised lesions on skin that has been in the sun for a long period of time, although they are pre-cancerous lesions. These lesions are usually benign but can develop into skin cancer; therefore, further evaluation is needed to determine whether removal is required. Fingernail pitting is correlated with Psoriasis can cause pitting on all finger and toenails, along with thickening and an irregular shape of the nail. Emphysema is characterized by (3) barrel-shaped chest, pursed-lip breathing, and dyspnea when at rest Infiltrates on an x-ray indicate bacterial infection, such as pneumonia. The "blue dot" sign The blue dot sign describes a tender nodule located underneath the skin of the testicle that appears as a round, blue-to-purple mass. Also known as torsion of testicular appendage, it is not an emergent condition. It is the most common cause of testicular area pain in younger boys. Treatment is symptomatic. Finasteride (Proscar) belongs to the drug class called 5-alpha reductase inhibitors. It helps to lower serum testosterone, which helps to decrease the size of the prostate. It is also used for male-pattern baldness. A smaller prostate results in less obstructive voiding symptoms such as weak stream, frequency, and nocturia.